project is established, it can be supported, if need be, through support grants, while extension and improvement funds are released for other extension and improvement projects. We see in this separate authorization for extension and improvement grants no infringement on the exercise of State initiative and responsibility. In fact, the incentive of increased Federal matching during the first few years of a new or improved program should prove to be very beneficial to the States. We therefore cannot agree to the AMA proposal and urge the committee to retain the extension and improvement grant concept in the bill as written. We appreciate this additional opportunity to present our views and will be pleased to cooperate with the committee in its further deliberations on this bill. Sincerely yours, NELSON A. ROCKEFELLER, MENTAL HEALTH AMENDMENT Acting Secretary. (The following material regarding a proposed amendment concerning mental health grants was submitted for the record:) Hon. CHARLES A. WOLVERTON, APRIL 14, 1954. Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington 25, D. C. DEAR MR. CHAIRMAN: This is in response to your request for our views and technical assistance with respect to a proposed amendment to H. R. 7397 which would, in effect, exclude mental health grants from the consolidation, as provided in the bill, of all categorical public health grants to States. Such an exception would, as you are aware, run contrary to our conclusion that, while the disease categorical grants have served a useful function, the time has arrived when the best interests of the States and the Federal Government would be served by a consolidation of present categories. We cannot, therefore, agree with the desirability of the proposed committee amendment. However, if your committee believes that there is need for a further continuation of categorical aid for mental health, we would not be unalterably opposed to such an amendment, provided that it is limited to a specific time period of not to exceed 5 years following enactment. Such a time limitation would constitute a recognition of the principle that categorical grants should not be regarded as permanent in nature but should be periodically reviewed and appraised by the Congress to determine whether the purpose of a separate grant has been substantially achieved. We also believe that the statutory provisions for any extension of categorical aid for mental health should follow as closely as possible the present provisions of law relating to mental health grants. This would emphasize the intent of the committee merely to extend an existing authorization, rather than to establish a new or revised mental health control grant as a part of the general revision of the public health grant-in-aid structure. Attached is a draft of amendments to H. R. 7397 which would accomplish the committee's objective in what we believe would be the most practical manner. The major features of this draft amendment may be summarized as follows: 1. A separate appropriation for the mental health grants would be specifically authorized for all fiscal years up to and including the fiscal year ending June 30, 1959. This would permit continuation of this categorical grant for 5 additional years after the current fiscal year, i. e., 4 fiscal years after the new proposal in H. R. 7397 becomes effective. 2. As under existing law, the separate appropriation for mental health grants would be allotted pursuant to regulations of the Surgeon General on the basis of the population, the extent of the mental health problem, and the financial need of the respective States. However, these funds would be matched by the States in the same manner as support grants under the bill are required to be matched instead of being matched on the two-to-one Federal-State ratio provided under existing regulations. This shift from the present matching formula to the same variable matching formula as is proposed for all support grants under the bill is believed to be more realistic in the light of State funds currently available for mental-health and other public-health purposes; it is also necessary to avoid the administrative complications that would result, particularly in States which do not have separate mental-health authorities, from having different matching formulas for the two types of grants. 3. The attached draft would also amend the provision of the bill on submission and approval of State plans so as to make it clear that in States with separate mental-health authorities, the separate authorities would be responsible for developing and submitting their plans to the Surgeon General without the necessity of review or approval by the overall State health authority. This amendment would be permanent in character, i. e., not limited to the period (ending June 30, 1959) during which separate grants and allotments for mental health would be authorized. 4. The transition or "bridge" provisions in the bill (sec. 3) would be changed to exclude the separate appropriations and allotments for mental health from consideration. Inasmuch as these separate appropriations and allotments will be earmarked for use exclusively in the field of mental health, it does not seem equitable to require that they be taken into account in determining, and making appropriate adjustments for, the effect of the new formulas upon the States. We would be glad to make available such additional information or technical assistance in perfecting the attached draft amendment or on other matters relating to the bill as your committee may request. Sincerely yours, NELSON A. ROCKEFELLER, Acting Secretary. AMENDMENT TO H. R. 7397 (MENTAL HEALTH AMENDMENT) Page 6, between lines 13 and 14, insert the following new subsection: "(e) (1) There are hereby authorized to be appropriated for the fiscal year ending June 30, 1955, and for each of the four suc.eecing fiscal year, in addi ion to the sums authorized to be appropriated pursuant to subsection (a), such sums as the Congress may determine for grants to States to assist them in meeting the costs of maintaining, and of extending and improving, their public health services in the field of mental health. "(2) From the sums appropriated pursuant to paragraph (1) the Surgeon General, in accordance with regulations, shall from time to time make allotments to the several States on the basis of (A) the population, (B) the extent of the mental health problem, and (C) the financial need of the respective States. "(3) From each State's allotment under this subsection for any fiscal year, the Surgeon General shall pay to such State an amount equal to its Federal share (as determined under subsection (k)) of the cost of public health services in the field of mental health under the plan of such State approved under subsection (f), including the cost of training of personnel for State and local mental health work and including the cost of administration of so much of the State plan as relates to work in the field of men'al health. "(4) Nothing in this subsection shall in any way affect the availability of grants to the States under subsection (b) or (c) for work in the field of mental health. "(5) No payment may be made from an allotment under this subsection with respect to any cost with respect to which any payment is made under subsection (b) or (c)." Redesignate the succeeding subsections of the proposed section 314, and references thereto, accordingly. Page 3, line 18, insert "or plans" after "plan". Page 4, line 18, insert "or plans" after "plan". Page 4, line 20, insert “(or one of the State plans)" after "plan". Page 6, strike out the material within the parentheses in lines 9 and 10 and insert the following sentence at the end of line 13: "In the case of any State for which the State mental health authority is not the State health authority, a separate State plan shall be submitted by such mental health authority relating to work in the field of mental health; and the Surgeon General shall approve any such plan which meets such requirements as he may prescribe by regulation." Page 6, lines 15 and 16, strike out "subsection (b) and (c) of". Page 6, line 16, insert "(other than grants under subsection (d))" after "section". Page 7, line 7, insert "submitted by such authority and" after "plan". Page 7, lines 16 and 22, strike out "or (c)" and insert in lieu thereof ", (c), or (e)". Page 9, line 7, strike out "or (c)" and insert in lieu thereof ", (c), or (e)”. Page 9, lines 20 and 22, strike out "section" and insert in lieu thereof "subsection". Page 11, line 18, strike out "1955" and insert in lieu thereof "1955 (other than so much thereof as was allotted to such State for work in the field of mental health)". April 2, 1954. NEW JERSEY NEUROPSYCHIATRIC ASSOCIATION, Hon. CHARLES WOLVERTON, House Office Building, Washington, D. C. MY DEAR MR. WOLVERTON: It has just come to the attention of the Council of the New Jersey Neuropsychiatric Association that pending legislation, S. 2778 and H. R. 7397, is under discussion in Congress pertaining to the consolidation of all Federal health grants. Since our organization is specifically interested in mental health, we view this pending legislation with concern, since it might be possible that the usual grants for mental health may not in the future be forthcoming, especially if the decision remains entirely up to the States where interest in mental health may be lacking. The mentally ill have been and continue to be in need of as much assistance as is possible and therefore our organization would not look upon, with any degree of favor, any changes that might decrease help in the field of mental health. I trust that you will take our feelings into consideration in the deliberation of this new legislation. With many thanks for your kind consideration, I am Respectfully, FRANK P. PIGNATARO, M. D., President. NEW BRUNSWICK, N. J., April 2, 1954. Passage would be crippling Representative CHARLES Wolverton, President, Middlexex County Mental Health Association. Hon. CHARLES WOLVERTON, MORRISTOWN, N. J., April 8, 1954. House Office Building, Washington, D. C. Community mental health services in our State threatened by H. R. 7397. Urge your opposition to this legislation. MORRIS COUNTY ASSOCIATION FOR MENTAL HEALTH. INDIANA ASSOCIATION FOR MENTAL HEALTH, Hon. CHARLES WOLVERTON, Member of Congress, House Office Building, Washington, D. C. DEAR CONGRESSMAN WOLVERTON: May I call your attention to a situation that can adversely affect the mental health programs of the people of Indiana and, in our opinion, those of every other State in the Union. In 1946 Congress took a great step forward in passing the National Mental Health Act. This act made it possible for the United States Public Health Service to make grants available to the States-including Indiana-for clinics, training, research, public education, and other forms of prevention. In Indiana this act means a great deal to the 100,000 citizens with close relatives in State hospitals, as well as having great future significance for many times this number. Our understanding is that the House has before it a measure, H. R. 7397 (in the Senate Subcommittee on Health, S. 2778), that would end the present type of grants and bury them as part of one general health grant, which in turn would be administered by State health departments. So far the grants are small. In Indiana they are in the neighborhood of $70,000. However, they have an influence as the basis of creating local psychiatric clinics, all of which can be destroyed if this aid were eliminated. I know of nothing more dangerous to the present and future victims of mental disaster than this proposed change in the grants that serves as a coverup for future diversion of funds. I believe, sir, you will earn the gratitude of a great number of people if you were to use your influence now—and your vote, later, if necessary-to oppose this measure. Sincerely yours, JOSEPH R. BROWN, Executive Director. FLOYD COUNTY CHAPTER, Hon. CHARLES WOLVERTON, INDIANA ASSOCIATION FOR MENTAL HEALTH, House Office Building, Washington, D. C. DEAR SIR: It has come to our attention that Congress has before it a measure (S. 2778 and H. R. 7397) which would make it impossible for Federal grants to be specifically designated for mental-health purposes. Instead this bill would bury these grants as part of one general health grant, which in turn would be administered by the State health department. With the passage of the 1946 National Mental Health Act it has been possible for the United States Public Health Service to make grants available to the States for clinics, training research, public education, and other forms of prevention. All of this can be gravely handicapped if the Federal Government aid is eliminated. The Floyd County (Ind.) Association for Mental Health knows of nothing more dangerous to the present and future victims of mental illness than this proposed change in the grants which serves as a coverup for future diversion of funds. We would appreciate any influence which you may exert to oppose this measure. Sincerely yours, LOLA K. SLOAN, President, Floyd County Chapter. VIGO COUNTY ASSOCIATION FOR MENTAL HEALTH, Hon. CHARLES WOLVERTON, DEAR CONGRESSMAN WOLVERTON: May I call your attention to a situation that can adversely affect the mental health programs of these United States. The measure which is now before the Senate Subcommittee on Health would eliminate specific grants to organizations such as ours. It would, instead, establish one fund to be administered by a State health department. Only with individual grants may we have the necessary funds for distribution where the need is greatest. Our major project at present is education of the public. Some other organizations have already established their educational programs, and are not in need of stressing this phase of their work. Please give all phases of this problem you consideration, and help us defeat this bill, S. 2778, for the good of many. Very truly yours, Dr. RUTHERFORD B. PORTER. VERMONT ASSOCIATION FOR MENTAL HEALTH, INC., Representative CHARLES WOLVERTON, House Office Building, Washington, D. C. April 1, 1954. DEAR REPRESENTATIVE WOLVERTON: We would like to recommend that you vote against House bill 7397. We feel that it is far too important to have mental health, our No. 1 illness, submerged in State health departments. We believe it of vital importance for the alleviation of mental illness that there be a separate mental health authority in the various States. Sincerely, JAMES G. YOUNG, President. SOUTH DAKOTA MENTAL HEALTH ASSOCIATION, Representative CHARLES WOLVERTON, Chairman of the House Interstate Commerce Commission, House Office Building, Washington 25, D. C. MY DEAR REPRESENTATIVE WOLVERTON: As chairman of the Brookings area chapter of the South Dakota Mental Health Association, it has come to my attention that you have House of Representatives bill H. R. 7397 now under consideration. The principle of this bill may be worthy, but in actual practice at the present time I feel that pooling of grants could jeopardize our mental health program. We are still in the early stages of organization and recognition in most parts of the country, and can ill afford to have any of our funds removed to another illness category, as could be done under this bill. That we might stand to benefit is doubtful. I understand that the State health officers, when they took action through their official organization approving this bill, did not call for the opinion of the State mental health authorities in so doing. Is this not a significant oversight? May I ask your thoughtful consideration of this matter? Hon. CHARLES WOLVERTON, Mrs. GLENN AVERY, Chairman, Brookings Area Chapter. AMERICAN PSYCHIATRIC ASSOCIATION, Washington, D. C., April 8, 1954. Chairman, House Interstate Commerce Committee, DEAR CONGRESSMAN WOLVERTON: I respectfully call your attention to this association's opposition to H. R. 7397, a bill now being considered in executive session by the House. This bill would replace separate categorical grants with one general health grant. It would wipe out separate mental health grantsin-aid for community services (mental health clinics). Federal grants-in-aid for community mental health services have been the greatest single stimulus to the development of mental health clinics in the various States in the past decade. In the rapid development of such services lies the main hope for reducing gradually the growing burden of mental hospitalization in this country. If responsibility for the utilization of such money is transferred from the mental health authorities in the States to public health departments, it can only mean that mental health will be placed in a competitive position with other public health needs. This would not be a matter of such concern if standards for the treatment and care of the mentally ill in this country approached anything like the standards we take for granted in other health fields. But they do not and until they do singular methods must be utilized to deal with a singular need. Last October, representatives of this and other leading national organizations and agencies testified at great length on the mental-health needs of the Nation before the Wolverton committee. We believe that any Member of the Congress who reviews this testimony now published, will agree that the meager headway now being made in tackling mental illness should not be further jeopardized by placing mental-health needs in competition with other health needs for Federal funds. We should be happy to offer further testimony in support of our position. Sincerely yours, DANIEL BLAIN, M. D., Medical Director. |